Provider Demographics
NPI:1104827278
Name:HERRERA, JESUS (MD)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:HERRERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8TH STREET AND GIRARD AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19122
Mailing Address - Country:US
Mailing Address - Phone:215-787-2000
Mailing Address - Fax:215-778-6990
Practice Address - Street 1:3156 KENSINGTON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-2400
Practice Address - Country:US
Practice Address - Phone:215-291-8151
Practice Address - Fax:215-423-9600
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4257732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
I26994Medicare UPIN
PA089345HFHMedicare ID - Type Unspecified